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Sugai T, Uesugi N, Suzuki M, Suzuki N, Honda M, Abe T, Yanagawa N. A rare case of neuroendocrine cell tumor mixed with a mucinous component in the ampulla of Vater. Diagn Pathol 2024; 19:64. [PMID: 38678248 PMCID: PMC11055287 DOI: 10.1186/s13000-024-01488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND A rare case of neuroendocrine cell tumor (NET) having both conventional and mucinous components was reported. Mucinous NET is rarely encountered in the pathological diagnosis of gastrointestinal (GI) tumors. Here we examined the mechanism for transformation of conventional NETs into mucinous NETs. CASE PRESENTATION Macroscopic examination revealed a tumor with ulceration in the ampulla of Vater that measured 1.7 cm in its largest diameter. Histologically, the tumor comprised two components: a tubular/ribbon-like feature and small nests floating in a mucinous lake. The tumor nests showed sheet, nest and ribbon-like structures of small cells having eosinophilic cytoplasm as well as small-sized nuclei with dense hyperchromatin. Immunohistochemical analysis showed tumor cells positive for pan-endocrine markers (synaptophysin, CD56, INSM1 and chromogranin). Based on the histological findings, the solid and mucinous components were diagnosed as conventional and mucinous NETs, respectively. Grading was NET G2 based on 12.8% and 13.2% Ki-67-positive cells in the solid and mucinous components, respectively. Immunohistochemically, the mucin phenotype of this tumor was gastric and intestinal. Only the mucinous NET component had cytoplasmic CD10 expression. Examination using a customized gene panel detected only a DPC4 mutation, which was limited to the mucinous component. CONCLUSIONS Coexistence of conventional and mucinous NETs could provide important insight into evaluating the NET subtype histogenesis. Moreover, molecular alterations including cytoplasmic expression of CD10 and the DPC4 mutation can contribute to interpretation of tumor pathogenesis.
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Affiliation(s)
- Tamotus Sugai
- Diagnostic Pathology Center, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Kooriyama City, Fukushima, 963-8563, Japan.
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 2-1-1, Shiwagun, Yahabachou, 028-3695, Japan.
| | - Noriyuki Uesugi
- Diagnostic Pathology Center, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Kooriyama City, Fukushima, 963-8563, Japan
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 2-1-1, Shiwagun, Yahabachou, 028-3695, Japan
| | - Masamichi Suzuki
- Diagnostic Pathology Center, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Kooriyama City, Fukushima, 963-8563, Japan
| | - Nobuyasu Suzuki
- Department of Surgery, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama City, Fukushima, 963-8563, Japan
| | - Michitaka Honda
- Department of Surgery, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama City, Fukushima, 963-8563, Japan
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka Fukushima, Fukushima, 960-1295, Japan
| | - Tsuyoshi Abe
- Department of Surgery, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama City, Fukushima, 963-8563, Japan
| | - Naoki Yanagawa
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 2-1-1, Shiwagun, Yahabachou, 028-3695, Japan
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Hamada K, Irisawa A, Horikawa Y, Shiwa Y, Techigawara K, Ishikawa M, Nagahashi T, Fukushima D, Nishino N, Sakuma H, Honda M. Neuroendocrine tumor of the ampulla of Vater treated with endoscopic papillectomy: A case report. DEN OPEN 2023; 3:e191. [PMCID: PMC9702364 DOI: 10.1002/deo2.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/06/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Koichi Hamada
- Department of Gastroenterology Southern‐Tohoku General Hospital Fukushima Japan
- Department of Minimally Invasive Surgical and Medical Oncology Fukushima Medical University Fukushima Japan
| | - Atsushi Irisawa
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology Southern‐Tohoku General Hospital Fukushima Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology Southern‐Tohoku General Hospital Fukushima Japan
| | - Kae Techigawara
- Department of Gastroenterology Southern‐Tohoku General Hospital Fukushima Japan
| | - Masafumi Ishikawa
- Department of Gastroenterology Southern‐Tohoku General Hospital Fukushima Japan
| | - Takayuki Nagahashi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Daizo Fukushima
- Department of Gastroenterology Southern‐Tohoku General Hospital Fukushima Japan
| | - Noriyuki Nishino
- Department of Gastroenterology Southern‐Tohoku General Hospital Fukushima Japan
| | - Hideo Sakuma
- Department of Pathology Southern‐Tohoku General Hospital Fukushima Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology Fukushima Medical University Fukushima Japan
- Department of Surgery Southern‐Tohoku General Hospital Fukushima Japan
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Vanoli A, Grami O, Klersy C, Milanetto AC, Albarello L, Fassan M, Luchini C, Grillo F, Spaggiari P, Inzani F, Uccella S, Parente P, Nappo G, Mattiolo P, Milione M, Pietrabissa A, Cobianchi L, Schiavo Lena M, Partelli S, Di Sabatino A, Sempoux C, Capella C, Pasquali C, Doglioni C, Sessa F, Scarpa A, Rindi G, Paulli M, Zerbi A, Falconi M, Solcia E, La Rosa S. Ampullary Neuroendocrine Neoplasms: Identification of Prognostic Factors in a Multicentric Series of 119 Cases. Endocr Pathol 2022; 33:274-288. [PMID: 35553369 PMCID: PMC9135850 DOI: 10.1007/s12022-022-09720-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/29/2022]
Abstract
Neuroendocrine neoplasms (NENs) of the major and minor ampulla are rare diseases with clinico-pathologic features distinct from non-ampullary-duodenal NENs. However, they have been often combined and the knowledge on prognostic factors specific to ampullary NENs (Amp-NENs) is limited. The aim of this study was to identify factors associated with metastatic potential and patient prognosis in Amp-NENs. We clinically and histologically investigated an international series of 119 Amp-NENs, comprising 93 ampullary neuroendocrine tumors (Amp-NETs) and 26 neuroendocrine carcinomas (Amp-NECs). Somatostatin-producing tubulo-acinar NET represented the predominant Amp-NET histologic subtype (58 cases, 62%, 12 associated with type 1 neurofibromatosis). Compared to Amp-NETs, Amp-NECs arose in significantly older patients and showed a larger tumor size, a more frequent small vessel invasion, a deeper level of invasion and a higher rate of distant metastasis, and, importantly, a tremendously worse disease-specific patient survival. In Amp-NETs, the WHO grade proved to be a strong predictor of disease-specific survival (hazard ratio: 12.61, p < 0.001 for G2 vs G1), as well as patient age at diagnosis > 60 years, small vessel invasion, pancreatic invasion, and distant metastasis at diagnosis. Although nodal metastatic disease was not associated with survival by itself, patients with > 3 metastatic lymph nodes showed a worse outcome in comparison with the remaining Amp-NET cases with lymphadenectomy. Tumor epicenter in the major ampulla, small vessel invasion, and tumor size > 16 mm were independent predictors of nodal metastases in Amp-NETs. In conclusion, we identified prognostic factors, which may eventually help guide treatment decisions in Amp-NENs.
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Affiliation(s)
- Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Via Carlo Forlanini 16 - 27100, Pavia, Italy.
- Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy.
| | - Oneda Grami
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Via Carlo Forlanini 16 - 27100, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Caterina Milanetto
- Department of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, Padua, Italy
| | - Luca Albarello
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
- Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Centre, University of Verona, Verona, Italy
| | - Federica Grillo
- Department of Surgical and Diagnostic Sciences, Pathology Unit, University of Genoa, Genoa, Italy
| | - Paola Spaggiari
- Pathology Department, Humanitas Clinical and Research Center-IRCCS Rozzano, Milan, Italy
| | - Frediano Inzani
- Department of Woman and Child Health Sciences and Public Health, Anatomic Pathology Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Rome ENETS Center of Excellence, Rome, Italy
| | - Silvia Uccella
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Paola Parente
- Unit of Pathology, Fondazione IRCCS Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Gennaro Nappo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Massimo Milione
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Andrea Pietrabissa
- General Surgery Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Lorenzo Cobianchi
- General Surgery Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Christine Sempoux
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carlo Capella
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Claudio Pasquali
- Department of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, Padua, Italy
| | - Claudio Doglioni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fausto Sessa
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Centre, University of Verona, Verona, Italy
| | - Guido Rindi
- Department of Woman and Child Health Sciences and Public Health, Anatomic Pathology Unit, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Rome ENETS Center of Excellence, Rome, Italy
- Department of Life Sciences, Section of Anatomic Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Paulli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Via Carlo Forlanini 16 - 27100, Pavia, Italy
- Anatomic Pathology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Enrico Solcia
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Via Carlo Forlanini 16 - 27100, Pavia, Italy
| | - Stefano La Rosa
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Van Treeck BJ, Dasari S, Kurtin PJ, Theis JD, Nasr SH, Zhang L, Yasir S, Graham RP, McPhail ED, Said S. Somatostatin-derived amyloidosis: a novel type of amyloidosis associated with well-differentiated somatostatin-producing neuroendocrine tumours. Amyloid 2022; 29:58-63. [PMID: 34541974 DOI: 10.1080/13506129.2021.1979512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report the clinicopathologic and proteomic characteristics of a novel form of amyloidosis derived from the precursor protein somatostatin. MATERIALS AND METHODS Cases were identified by searching the Mayo Clinic amyloid liquid chromatography and tandem mass spectrometry (LC-MS/MS) typing database from 1 January 2008 to 1 September 2020 for specimens with the amyloid signature proteins and abundant somatostatin, in the absence of other amyloid precursor proteins. All available medical records and pathologic materials were examined. RESULTS Somatostatin-derived amyloid deposits were found in four patients, two females and two males, with a median age of 61.5 years (range 47-73 years). One patient also had neurofibromatosis-1. The amyloid in each case was associated with a well-differentiated, somatostatin-producing neuroendocrine tumour arising in the small bowel or pancreas. The amyloid deposits were Congo Red-positive and were readily identified by LC- MS/MS analysis. Somatostatin was present exclusively in somatostatin-associated amyloid cases (p < .001), compared to small bowel and pancreas amyloidosis cases of other types. Long-term follow-up is available for one patient who is alive 6 years after initial presentation. CONCLUSION We propose that somatostatin-related amyloidosis is a novel localised human amyloid type that arises in association with well-differentiated somatostatin-producing enteropancreatic neuroendocrine tumours. Treatment of the associated neuroendocrine tumour may be adequate therapy for these patients.
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Affiliation(s)
| | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Paul J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jason D Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lizhi Zhang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Saba Yasir
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Samar Said
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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5
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Neuroendocrine tumor of the ampulla of Vater showing chronological endoscopic changes. Clin J Gastroenterol 2022; 15:205-209. [PMID: 35113343 DOI: 10.1007/s12328-021-01553-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
We report a rare case of neuroendocrine tumor of the ampulla of Vater in a 53-year-old Japanese male. The patient was admitted to our institution for workup of presyncope secondary to anemia. Medical history was pertinent for coronary artery disease, for which he had drug eluting stents (DES) placed and was on aspirin and clopidogrel therapy. Upper endoscopic evaluation revealed bleeding from an erosion at the ampulla of Vater. Endoscopic therapy with epinephrine and thrombin injection allowed for successful hemostasis and repeat endoscopy 6 months later did not show any changes in lesion character. Repeat endoscopy at 1 year, however, revealed erythema and further erosion on the ampulla of Vater as the lesion had progressed. The patient was diagnosed with carcinoma of the ampulla of Vater. Abdominal computed tomography showed a 9-mm hypervascular tumor at the ampulla of Vater and the patient underwent open pancreatoduodenectomy and lymphadenectomy. Histologically, the tumor consisted of small-sized round cell proliferations with a solid nest pattern. Immunostaining results indicated that the tumor cells were positive for synaptophysin and 2.5% were positive for Ki-67. The final diagnosis was sporadic non-functional neuroendocrine tumor (NET) G1 of the ampulla of Vater. This case demonstrates that NET of the ampulla of Vater, while rare, can have significant changes and growth over time and highlights the importance of follow-up endoscopic evaluations.
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6
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Matli VVK, Wellman G, Jaganmohan S, Koticha K. Ampullary and Pancreatic Neuroendocrine Tumors: A Series of Cases and Review of the Literature. Cureus 2022; 14:e21657. [PMID: 35111492 PMCID: PMC8793321 DOI: 10.7759/cureus.21657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 01/15/2023] Open
Abstract
The ampulla of Vater is a unique, highly vascularized pouch. Its anatomic transition is halfway along the second part of the duodenum from the foregut to the midgut. According to the World Health Organization’s (WHO) latest nomenclature, carcinoid tumors are now called neuroendocrine tumors (NETs). Knowledge of NETs is important because of their rarity, reclassification, prognosis, and management. NETs involving the ampulla of Vater are extremely rare, constituting <0.05% of gastrointestinal NETs, and involving the pancreas are rare to our knowledge. There are only a few reports of ampullary NETs. We report two rare NET cases involving the ampulla and pancreas and review the relevant literature. A 71-year-old patient with neurofibromatosis and multiple comorbidities presented with chronic intermittent abdominal pain. Abdominal imaging studies showed a suspicious mass at the level of the ampulla. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound revealed bulging papillae. Histopathology of the biopsied mass revealed a low-grade NET. Given his multiple comorbidities, the patient was scheduled for endoscopic resection. Our second patient was an 83-year-old lady presenting with nausea and vomiting. Abdominal imaging studies revealed a lobular mass over the body of the pancreas. Histopathological examination of fine-needle aspiration of the mass confirmed a well-differentiated low-grade NET. Octreoscan and dotatate scans showed pancreatic, multiple hepatic and metastatic lesions in the left lung and left shoulder. The patient is currently stable after completing peptide receptor radioligand therapy at a tertiary oncology center. Because of the patients’ comorbidities and staging, their management has taken different approaches. More data and more research are needed for accurate assessment of prognosis; however, a review of the latest literature recommends Whipple resection with lymphadenectomy for all ampullary NETs provided patients can tolerate the procedure. Endoscopic resection or surgical ampullary resection should be performed on contraindicated patients. The majority of ampullary and pancreatic NETs would have metastasized by the time patients sought treatment. Because of their rarity and ill-defined and highly variable presentation, NET diagnosis is always delayed and sometimes incidental; therefore, we emphasize the importance of early diagnosis and management to reduce mortality and morbidity.
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7
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Schmocker RK, Wright MJ, Ding D, Javed AA, Cameron JL, Lafaro K, Burns WR, He J, Wolfgang CL, Burkhart RA. Duodenal, ampullary, and pancreatic neuroendocrine tumors: Oncologic outcomes are driven by tumor biology and tissue of origin. J Surg Oncol 2020; 123:416-424. [PMID: 33125737 DOI: 10.1002/jso.26285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Periampullary neuroendocrine tumors (NETs) arise from the duodenum, ampulla, and periampullary pancreas. Duodenal and ampullary NETs are rare and may have distinct biologic behavior from pancreatic NETs (P-NETs). We examined the outcomes of these entities. METHODS An institutional database was queried for patients undergoing resection for pancreatic head, duodenal, or ampullary NETs from 2000 to 2018. Patients with MEN1 syndrome or follow up less than 12 months were excluded. RESULTS Three hundred and ten patients were identified. Tumor locations were ampulla (n = 15), duodenum (n = 35) and pancreas (n = 260). Median follow-up and recurrence-free survival (RFS) were 60.9 (interquartile range [IQR]: 34.8-99.3) and 171.7 (IQR: 84.0-NR) months. Clinicopathologic data and survival outcomes were similar for duodenal and ampullary NETs (RFS: p = .347 and overall survival [OS]: p = .246) and were combined into an intestinal subtype (IS) group. There were no differences in OS or RFS when comparing IS-NET and P-NET. On multivariate analysis, tissue of origin was not associated with risk of recurrence. The current American Joint Committee on Cancer staging guidelines, which account for origin tissue, were predictive of outcomes for all subtypes. CONCLUSION Tissue of origin does not appear to impact long-term outcomes when comparing IS-NETs and P-NETs. The AJCC staging system offers good discriminatory capacity in the context of the tissue type.
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Affiliation(s)
- Ryan K Schmocker
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Division of Surgical Oncology, Department of Surgery, The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Michael J Wright
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ding Ding
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ammar A Javed
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - John L Cameron
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kelly Lafaro
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - William R Burns
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jin He
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Christopher L Wolfgang
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Richard A Burkhart
- The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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8
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Shimai S, Yamamoto K, Sofuni A, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Honjo M, Mukai S, Fujita M, Nagai K, Asai Y, Matsunami Y, Kurosawa T, Kojima H, Honma H, Minami H, Yamaguchi H, Itoi T. Three Cases of Ampullary Neuroendocrine Tumor Treated by Endoscopic Papillectomy: A Case Report and Literature Review. Intern Med 2020; 59:2369-2374. [PMID: 32611953 PMCID: PMC7644498 DOI: 10.2169/internalmedicine.4568-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We herein report three cases of patients with an ampullary neuroendocrine tumor (NET), who underwent endoscopic papillectomy (EP). No tumor recurrence or metastasis was detected in the patients for more than two years after EP. Generally, surgical resection is recommended for ampullary NETs by the European Neuroendocrine Tumor Society. However, as EP is less invasive than surgical resection, there are some reports of low-grade small ampullary NETs curatively treated by EP with long-term follow-up. We consider that EP may be a curative treatment for small and low-grade ampullary NETs without regional or distant metastasis.
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Affiliation(s)
- Satoshi Shimai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Kenjiro Yamamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Mitsuyoshi Honjo
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Mitsuru Fujita
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Kazumasa Nagai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Yasutsugu Asai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Yukitoshi Matsunami
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Takashi Kurosawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Hiroyuki Kojima
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Hirotoshi Honma
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Hiroto Minami
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | | | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
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9
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Panzuto F, Massironi S, Partelli S, Campana D, Rinzivillo M, Invernizzi P, Andreasi V, Lamberti G, Falconi M. Gastro-entero-pancreatic neuroendocrine neoplasia: The rules for non-operative management. Surg Oncol 2020; 35:141-148. [PMID: 32877883 DOI: 10.1016/j.suronc.2020.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/26/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023]
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) with favorable pathological and clinical features may be considered as indolent lesions, and therefore be amenable to conservative management. According to the primary tumor site, different non-aggressive approaches, based on endoscopic resection or simple active surveillance, can be proposed to selected patients fulfilling specific criteria. Tumor size, Ki67 proliferative index and depth of invasion are markers that can be used in order to identify these subjects. Patients with type I gastric NENs <1 cm as well as those with non-ampullary duodenal NENs <1 cm with no associated syndrome can be safely managed by endoscopic resection. On the other hand, an active surveillance approach is preferred over surgery for patients with asymptomatic, non-functioning pancreatic NENs ≤2 cm without dilation of the main pancreatic duct or bile duct. As far as NENs of the appendix are concerned, appendectomy should be considered as curative when a R0 resection has been achieved in the presence of a tumor ≤1.5 cm, graded as G1 and without lymphovascular invasion. Finally, G1 rectal NENs ≤1 cm without invasion of the muscular layer can be safely treated by endoscopic resection. Therefore, surgeons should be aware of the existence of indolent GEP-NENs, in order to avoid unnecessary operations with associated postoperative complications.
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Affiliation(s)
- Francesco Panzuto
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy.
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute - Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Campana
- Division of Oncology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Rinzivillo
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Valentina Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute - Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Lamberti
- Division of Oncology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute - Vita-Salute San Raffaele University, Milan, Italy
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10
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Jeha GM, Philip Boudreaux J, Woltering EA, Bren-Mattison Y, Thiagarajan R. Neuroendocrine Tumors of the Ampulla of Vater Treated With Local Resection. Am Surg 2020; 86:1575-1576. [PMID: 32731745 DOI: 10.1177/0003134820940247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- George M Jeha
- 12258 Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - J Philip Boudreaux
- 12258 Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Eugene A Woltering
- 12258 Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Yvette Bren-Mattison
- 12258 Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Ramcharan Thiagarajan
- 12258 Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
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11
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Sun S, Wang W, He C. Development and Validation of Prognostic Nomograms for Patients with Duodenal Neuroendocrine Neoplasms. Med Sci Monit 2020; 26:e922613. [PMID: 32564052 PMCID: PMC7331477 DOI: 10.12659/msm.922613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background This study was designed to predict prognosis of patients with primary duodenal neuroendocrine neoplasms (D-NENs) by developing nomograms. Material/Methods Patients diagnosed with D-NENs between 1988 and 2015 were queried from the SEER database and a total of 965 appropriate cases were randomly separated into the training and validation sets. Kaplan-Meier analysis was used to generated survival curves, and the difference among the groups was assessed by the log-rank test. Independent prognostic indicators were acquired by Cox regression analysis, and were used to develop predictive overall survival (OS) and cancer-specific survival (CSS) nomograms. Harrell’s concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to assess the efficacy of nomograms. Tumor stage was regarded as a benchmark in predicting prognostic compared with the nomograms built in this study. Results The C-index was 0.739 (0.690–0.788) and 0.859 (0.802–0.916) for OS and CSS nomograms, respectively. Calibration curves exhibited obvious consistency between the nomograms and the actual observations. In addition, C-index, AUC, and DCA were better than tumor stage in the evaluative performance of nomograms. Conclusions The nomograms were able to predict the 1-, 5-, and 10-year OS and CSS for D-NENs patients. The good performance of these nomograms suggest that they can be used for evaluating the prognosis of patients with D-NENs and can facilitate individualized treatment in clinical practice.
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Affiliation(s)
- Shenghong Sun
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Wei Wang
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Chiyi He
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China (mainland)
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12
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Alekberzade AV, Krylov NN, Lipnitskiy EM, Shakhbazov RO, Azari F. [Gastric neuroendocrine tumors]. Khirurgiia (Mosk) 2019:111-120. [PMID: 31825351 DOI: 10.17116/hirurgia2019121111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Gastrointestinal neuroendocrine tumors are rare neoplasms. Currently, incidence of gastric neuroendocrine tumors (gNETs) is being significantly increased. There are 3 groups of gNETs: types I, II and III. Each type has important features regarding clinical picture, prognosis and treatment strategy. Type I is the most common (70-80%) and associated with chronic atrophic gastritis including autoimmune gastritis and Helicobacter associated atrophic gastritis. Type II (5-6%) is associated with multiple endocrine neoplasia type I and Zollinger-Ellison syndrome (MEN I - ZES). Both types are characterized by hypergastrinemia and small tumor dimension. These neoplasms are multiple and mostly benign. On the contrary, NETs type III (10-15%) is not associated with hypergastrinemia and represented by single large neoplasms. Tumors are malignant as a rule. Therefore, surgical resection and chemotherapy are preferred for these tumors. Endoscopic surgery followed by observation is acceptable for almost all NETS type I and II. At the same time, this approach is advisable only for small and highly differentiated neoplasms type III.
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Affiliation(s)
- A V Alekberzade
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - N N Krylov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E M Lipnitskiy
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - R O Shakhbazov
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - F Azari
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia PA, USA
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13
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Alekberzade AV, Krylov NN, Garmanova TN, Shahbazov R, Azari F, Zuykova KS, Litovchenko ED. [Duodenal neuroendocrine tumors]. Khirurgiia (Mosk) 2019:87-95. [PMID: 31355821 DOI: 10.17116/hirurgia201907187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Significant augmentation of the incidence of duodenal neuroendocrine tumors duodenum has been observed in recent decades. There are 5 histological types of these tumors: gastrinoma (50-60%), somatostatin-producing tumor (15%), inactive serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinoma (<3%) and gangliocytic paraganglioma (<2%). The majority of tumors are localized within the bulb and postbulbar part of duodenum, 20% are found in periampular area. Treatment strategy depends on dimensions, localization, histological class, stage and type of tumor. It is believed that endoscopic resection is permissible for small inactive tumors (G1) located above major duodenal papilla. The majority of other neoplasms requires surgical resection. Personal experience of various surgeons is limited by small group of patients. Therefore, it is necessary to summarize results for selection of optimal treatment.
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Affiliation(s)
- A V Alekberzade
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - N N Krylov
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - T N Garmanova
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - R Shahbazov
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - F Azari
- Department of Surgery, University of Pennsylvania, Philadelphia PA, USA
| | - K S Zuykova
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
| | - E D Litovchenko
- Sechenov First Moscow State Medical University of Ministry of Health of Russia, Moscow, Russia
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14
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Tsoli M, Chatzellis E, Koumarianou A, Kolomodi D, Kaltsas G. Current best practice in the management of neuroendocrine tumors. Ther Adv Endocrinol Metab 2019; 10:2042018818804698. [PMID: 30800264 PMCID: PMC6378464 DOI: 10.1177/2042018818804698] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 12/13/2022] Open
Abstract
Neuroendocrine neoplasms are rare tumors that display marked heterogeneity with varying natural history, biological behavior, response to therapy and prognosis. Their management is complex, particularly as a number of them may be associated with a secretory syndrome and involve a variety of options. A number of factors such as proliferation rate, degree of differentiation, functionality and extent of the disease are mostly utilized to tailor treatment accordingly, ideally in the context of a multidisciplinary team. In addition, a number of relevant scientific societies have published therapeutic guidelines in an attempt to direct and promote evidence-based treatment. Surgery remains the treatment of choice with an intention to cure while it may also be recommended in some cases of metastatic disease and difficult to control secretory syndromes. Long-acting somatostatin analogs constitute the main treatment for the majority of functioning tumors, whereas specific evolving agents such as telotristat may be used for the control of carcinoid syndrome and related sequelae. In patients with advanced disease not amenable to surgical resection, treatment options include locoregional therapies, long-acting somatostatin analogs, molecular targeted agents, radionuclides, chemotherapy and recently immunotherapy, alone or in combination. However, the ideal time of treatment initiation, sequence of administration of different therapies and identification of robust prognostic markers to select the most appropriate treatment for each individual patient still need to be defined.
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Affiliation(s)
| | - Eleftherios Chatzellis
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
| | - Anna Koumarianou
- Fourth Department of Internal Medicine, Attikon
University General Hospital, Athens, Greece
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
| | - Gregory Kaltsas
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
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15
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Rossi RE, Rausa E, Cavalcoli F, Conte D, Massironi S. Duodenal neuroendocrine neoplasms: a still poorly recognized clinical entity. Scand J Gastroenterol 2018; 53:835-842. [PMID: 29726295 DOI: 10.1080/00365521.2018.1468479] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Duodenal neuroendocrine neoplasms (dNENs) are rare tumors, which usually show good prognosis. The optimal management of these tumors is still far from being clearly understood because of their rarity and the poor level of knowledge about their natural history. Herein, we have reviewed the literature on dNENs to collect and analyze the current data on epidemiology, diagnosis and management of these rare tumors. METHODS Bibliographical searches were performed in PubMed, using the following keywords: duodenal neuroendocrine neoplasm; duodenum; gastrinoma; diagnosis; therapy; guidelines. We searched for all relevant articles published over the last 15 years. Non-English language papers were excluded. RESULTS We reviewed the pertinent articles about dNENs. Upper gastrointestinal endoscopy with biopsy is the cornerstone of the dNENs diagnostic process. Endoscopic ultrasound with fine-needle aspiration/biopsy should be performed in order to locally stage the disease and in all cases of non-diagnostic endoscopy. Endoscopic or complete surgical removal of the primary lesion is the recommended treatment and is generally achievable for the majority of the patients. A less aggressive approach may be suggested for well-differentiated low-stage tumors. After NEN removal, patients should be closely followed-up especially during the first 3 years by endoscopic examination, imaging tests and CgA measurements. CONCLUSIONS The multi-disciplinary approach and the preservation of the quality of life of the patients play a key role in the therapeutic process for dNENs. Further studies are needed to better define standardized guidelines specific to dNENs, including optimal management approaches and follow-up intervals.
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Affiliation(s)
- Roberta Elisa Rossi
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.,b Department of Pathophysiology and Organ Transplant , Università degli Studi di Milano , Milan , Italy
| | - Emanuele Rausa
- c General and Emergency Surgery Department , ASST Trauma Center "Papa Giovanni XXIII" Hospital , Bergamo , Italy
| | - Federica Cavalcoli
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.,b Department of Pathophysiology and Organ Transplant , Università degli Studi di Milano , Milan , Italy
| | - Dario Conte
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.,b Department of Pathophysiology and Organ Transplant , Università degli Studi di Milano , Milan , Italy
| | - Sara Massironi
- a Department of Gastroenterology and Endoscopy , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
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16
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Nicolas G, Nasser H, Haddad J, Zaghrini E, Daher K, Nasser AA, Saliba C, Gharios N, Wakim R. Periampullary Neuroendocrine Tumor as a Cause of Acute Pancreatitis. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1063-1067. [PMID: 30181528 PMCID: PMC6135042 DOI: 10.12659/ajcr.908205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 60 Final Diagnosis: Periampullary neuroendocrine tumor Symptoms: Abdominal discomfort Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Gregory Nicolas
- Department of Surgery, Lebanese American University Medical Center, Beirut, Lebanon
| | - Haydar Nasser
- Department of Surgery, Sacré Coeur Hospital, Beirut, Lebanon
| | - Juliano Haddad
- Department of Surgery, Lebanese University, Beirut, Lebanon
| | - Elie Zaghrini
- Department of Emergency Medicine, Lebanese American University, Beirut, Lebanon
| | - Karim Daher
- Department of Surgery, Lebanese American University Medical Center, Beirut, Lebanon
| | - Amal Assef Nasser
- Department of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christian Saliba
- Department of Surgery, Lebanese American University Medical Center, Beirut, Lebanon
| | | | - Raja Wakim
- Department of Surgery, Mount Lebanon Hospital, Beirut, Lebanon
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17
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Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature. J Gastrointest Surg 2018; 22:1652-1658. [PMID: 29869091 DOI: 10.1007/s11605-018-3825-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/17/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Duodenal neuroendocrine tumours (dNETs) comprise about 2% of all the NETs. Treatment of dNETs involves resection of the tumour either by endoscopic or surgical resection. Surgical or endoscopic local resection of the lesion is usually a more conservative and less morbid option compared with a more radical pancreaticoduodenectomy. However, inadequate clearance by local resection might result in recurrent disease with reduced overall survival. METHODS The current systematic review compared the differences in outcomes of endoscopic resection (ER), local resection (LR) and pancreaticoduodenectomy (PD) in the management of dNETs. Searches were performed on MEDLINE, PubMed, Embase and Cochrane databases using MeSH keyword combinations: 'duodenal', AND, 'neuroendocrine tumours'. All relevant articles published up to 2016 were included. Post-operative morbidity, R0 resection status and recurrence rates were the outcomes assessed. RESULTS Eight non-randomised retrospective studies with 335 participants were included (LR = 122; PD = 118; ER = 64). While PD was associated with higher morbidity compared with LR (27/64 vs. 10/74; P = 0.002), PD was associated with a higher incidence of an R0 resection (3/97 vs. 15/97; P = 0.007) as well as lower recurrence rates (3/51 vs. 6/46; P = 0.21). ER was associated with a higher positive resection margin status versus LR (22/51 vs. 14/91; P = 0.0002). Recurrence at follow-up was not different among patients with dNETs who underwent PD versus LR. CONCLUSIONS Radical surgical resection in the form of PD was associated with higher post-operative morbidity among patients with dNETs yet provided better margin clearance. Patients with dNETs need systematic evaluation with a view to obtain most of the information about the prognostic factors in order to tailor the treatment options.
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18
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Dhaduk VR, Johri V, Majesty SRH, Mushtaque N, Jain N, Reddy PK. Laparoscopic resection of duodenal carcinoid: A feasible method: Single institute case series. J Minim Access Surg 2018; 16:24-29. [PMID: 30106022 PMCID: PMC6945343 DOI: 10.4103/jmas.jmas_131_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Duodenal carcinoids (neuroendocrine tumour) are rare tumour, but recently, increase in incidence has been noted. Various techniques for excision of tumour have been described in literature, but very few case reports and case series have mentioned about laparoscopic management of carcinoid tumour. We describe a case series of seven cases of duodenal non-periampullary carcinoids which was managed by laparoscopic method. Aims The aim of the study was to check feasibility of laparoscopic management of duodenal carcinoid and technique of surgery. Settings and Design This study design was a case series and prospective data were retrospectively collected. Materials and Methods A total of 7 patients were operated for carcinoid tumour of duodenum mainly involving first part by laparoscopic method from February 2016 to January 2017. All patients were followed up for minimum 1-year period and various pre-operative, intra-operative findings and post-operative outcome were noted. Results Out of seven patients, 6 patient were managed by laparoscopic duodenotomy and transduodenal excision whereas one patient required duodenectomy of first part. Mean operative time was 99 min, mean intraoperative blood loss was 55.7, mean hospital stay was 99.7 and no recurrence in a 1-year follow-up. Conclusions Laparoscopic excision of carcinoid tumour is safe, technically reproducible and feasible method.
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Affiliation(s)
- Vimalkumar R Dhaduk
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Vishwas Johri
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - S R Harshavardan Majesty
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Nadeem Mushtaque
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Nikunj Jain
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Prasanna Kumar Reddy
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
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19
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Ampullary neuroendocrine neoplasms: surgical experience of a rare and challenging entity. Langenbecks Arch Surg 2018; 403:581-589. [DOI: 10.1007/s00423-018-1695-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/06/2018] [Indexed: 02/06/2023]
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20
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Seo YK, Choi JS. Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:217-221. [DOI: 10.4166/kjg.2018.72.4.217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Young Kyeong Seo
- Division of Gastroenterology, Department of Internal Medicine, Seoul You Hospital, Division of Gastroenterology, Busan, Korea
| | - Jung Sik Choi
- Department of Internal Medicine, Busan Paik hospital, Inje University College of Medicine, Busan, Korea
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21
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Costamagna G, Boškoski I, Attili F. Endoscopic Diagnosis of Gastrointestinal and Pancreatic Neuroendocrine Tumors. Updates Surg 2018. [DOI: 10.1007/978-88-470-3955-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Management of Well-differentiated Gastroenteropancreatic Neuroendocrine Tumors (GEPNETs): A Review. Clin Ther 2017; 39:2146-2157. [PMID: 29173655 DOI: 10.1016/j.clinthera.2017.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Neuroendocrine tumors (NETs) are heterogeneous tumors that arise from the neuroendocrine cells of the digestive tract and other organs, such as the lung, ovary, and thyroid glands. They can be well differentiated or poorly differentiated, and management of these tumors differs for each histologic subtype. We have performed a review of NETs and focused on management of well-differentiated gastroenteropancreatic neuroendocrine tumors (GEPNETs) and carcinoid syndrome. METHODS A PubMed search was performed to obtain articles on the management of well-differentiated NETs. Using the key words neuroendocrine tumors, carcinoid, pNET, octreotide, somatostatin analogues, and radiolabeled therapy, we reviewed Phase II and III trials that were published over the past 30 years. We also reviewed guidelines from the European Neuroendocrine Tumor Society, North America Neuroendocrine Tumor Society, and National Comprehensive Cancer Network in our search. FINDINGS NETs are usually slow-growing tumors that remain asymptomatic for a long duration and can be either nonfunctioning or functioning. Surgical resection is recommended for locoregional disease, impending obstruction, symptom control, and advanced disease. Nonsurgical treatment options include somatostatin analogues (SSAs), multikinase inhibitors, targeted therapy, chemotherapy, and radiolabeled SSAs. Carcinoid syndrome is mainly treated with SSAs. IMPLICATIONS Although GEPNETs are slow-growing tumors, most patients are diagnosed with metastatic disease, and therefore it is important that the management of each patient be discussed in a multidisciplinary setting to optimize the treatment strategy. Patients should be considered for clinical trials and refractory cases referred to a specialty center.
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Weatherall T, Denbo J, Sharpe J, Martin M, O'Brien T, Gupta R, Groshart K, Behrman S, Dickson P. Well-Differentiated, Non-Functional, Non-Ampullary Duodenal Neuroendocrine Tumors: Toward Defining Evaluation and Management. World J Surg 2017; 41:844-850. [PMID: 27743074 DOI: 10.1007/s00268-016-3770-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Nonfunctional, non-ampullary duodenal neuroendocrine tumors (dNETs) are rare neoplasms, and specific treatment recommendations are less clear than for other NETs. MATERIALS AND METHODS We performed a retrospective review of patients (pts) with a diagnosis of dNET, excluding hormonally functional, ampullary, and high-grade tumors. Clinical data were evaluated to identify factors that might impact clinical staging and predictors of metastases. RESULTS Thirty-six pts were identified. Surgical resection was performed in 28 and endoscopic resection in 8. LNs were included in specimens of 19/28 (68 %) pts who underwent surgical resection (median #LNs 5, range 1-12). Of these 19 pts, 5 (26 %) were found to be LN+. Of LN+ pts, all had tumors ≤2 cm. When compared to LN- pts, LN+ pts were more likely to have muscularis propria (MP) invasion (80 vs. 23 %, p = 0.04). Tumor size, tumor grade, lymphovascular invasion, and multifocality were similar between LN+ and LN- patients. No pt was found to have distant metastases. Heterogeneity in clinical staging modalities and small number of pts evaluated prohibited meaningful analysis of most appropriate preoperative imaging. At a median follow-up of 25 months (range 9-139), no patient developed recurrence or experienced disease-specific death. CONCLUSIONS Non-functional, non-ampullary dNETs, particularly those with MP invasion, have a propensity to metastasize to regional LNs. However, these neoplasms appear to have a favorable prognosis. Further evaluation of preoperative imaging is required to better determine most appropriate clinical staging. A suggested workup and management strategy for prospective evaluation is proposed.
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Affiliation(s)
- Timothy Weatherall
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA
| | - Jason Denbo
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA
| | - John Sharpe
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA
| | - Michael Martin
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.,West Cancer Center, 7945 Wolf River Blvd, Germantown, TN, 38138, USA
| | - Thomas O'Brien
- Memphis Pathology Group, 1211 Union Avenue, Suite 300, Memphis, TN, 38104, USA
| | - Rajib Gupta
- Department of Pathology, University of Tennessee Health Science Center, 930 Madison Ave, 5th Floor, Memphis, TN, 38163, USA
| | - Kenneth Groshart
- Pathology Group of the Midsouth, 6019 Walnut Grove Rd, Memphis, TN, 38120, USA
| | - Stephen Behrman
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA
| | - Paxton Dickson
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA.
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Baxi AJ, Chintapalli K, Katkar A, Restrepo CS, Betancourt SL, Sunnapwar A. Multimodality Imaging Findings in Carcinoid Tumors: A Head-to-Toe Spectrum. Radiographics 2017; 37:516-536. [PMID: 28287937 DOI: 10.1148/rg.2017160113] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Carcinoid tumors are a rare biologically heterogeneous group of neuroendocrine tumors with a spectrum ranging from benign indolent to aggressive metastatic tumors. They belong to the category of amine precursor uptake and decarboxylase tumors, or apudomas. The most common sites for primary locations are the gastrointestinal and respiratory tracts; however, any organ can be involved. The clinical presentation depends on location, aggressiveness, production of biologically active amines and peptides, paraneoplastic syndromes, and tendency for metastasis. Their reported age-adjusted incidence has increased in recent years, partly due to improved detection at radiologic imaging and endoscopy. Not a ll neuroendocrine cell tumors are carcinoids. Numerous systems have been proposed regarding their nomenclature and classification. Cross-sectional and functional imaging plays an important role in diagnosis, lesion characterization, and staging. Awareness of nomenclature, classification, common sites of involvement, and imaging presentation are pivotal for making the diagnosis. Knowledge of the diverse clinical, pathologic, and radiologic spectrum of carcinoid tumors involving various organs of the body is important for diagnosis and patient management. ©RSNA, 2017.
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Affiliation(s)
- Ameya Jagdish Baxi
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Kedar Chintapalli
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Amol Katkar
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Carlos S Restrepo
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Sonia L Betancourt
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Abhijit Sunnapwar
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
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Surgical treatment of neuroendocrine tumors in the second portion of the duodenum: a single center experience and systematic review of the literature. Langenbecks Arch Surg 2016; 402:925-933. [DOI: 10.1007/s00423-016-1537-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
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Tsukagoshi M, Hosouchi Y, Araki K, Mochida Y, Aihara R, Shirabe K, Kuwano H. Neuroendocrine tumor of the ampulla of Vater with distant cystic lymph node metastasis: a case report. Surg Case Rep 2016; 2:73. [PMID: 27457078 PMCID: PMC4960074 DOI: 10.1186/s40792-016-0202-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/13/2016] [Indexed: 11/28/2022] Open
Abstract
Background Neuroendocrine tumors (NETs) of the ampulla of Vater are rare and difficult to diagnose. We report a rare case of a small NET of the ampulla of Vater with metastasis to distant lymph nodes. Case presentation The patient was a 54-year-old man complaining of epigastric pain and melena. Upper gastrointestinal endoscopy revealed a bulging papilla with active bleeding, which was diagnosed as a well-differentiated NET of the ampulla of Vater. An approximately 10-mm hypervascular tumor at the ampulla of Vater and a 41-mm cyst adjacent to the wall of the jejunum were revealed by abdominal computed tomography. We performed pylorus-preserving pancreaticoduodenectomy with lymph node dissection. Macroscopic examination revealed a 9-mm tumor of the ampulla of Vater and a 52-mm cyst adjacent to the wall of the jejunum. Histological examination revealed that the cyst was a lymph node metastasis. The final diagnosis was non-functional NET G1 of the ampulla of Vater, designated T1N1M0 stage IIIB. Postoperatively, the patient underwent no treatment and has had no recurrence for 4 years. Conclusions This case demonstrates that sporadic NETs of Vater’s papilla have aggressive metastatic potential even with a small primary lesion, and radical resection with lymphadenectomy is recommended for all cases.
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Affiliation(s)
- Mariko Tsukagoshi
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Department of Surgery and Laparoscopic Surgery, Gunma Prefecture Saiseikai-Maebashi Hospital, 564-1 Kamishinden-machi, Maebashi, Gunma, 371-0821, Japan
| | - Yasuo Hosouchi
- Department of Surgery and Laparoscopic Surgery, Gunma Prefecture Saiseikai-Maebashi Hospital, 564-1 Kamishinden-machi, Maebashi, Gunma, 371-0821, Japan
| | - Kenichiro Araki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Yasushi Mochida
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ryusuke Aihara
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Department of Surgery and Laparoscopic Surgery, Gunma Prefecture Saiseikai-Maebashi Hospital, 564-1 Kamishinden-machi, Maebashi, Gunma, 371-0821, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Baptiste GG, Postlewait LM, Ethun CG, Le N, Russell MC, Kooby DA, Staley CA, Maithel SK, Cardona K. Is there an Optimal Surgical Approach to Neuroendocrine Tumors of the Ampulla? A Single Institution Experience over 15 Years. Am Surg 2016. [DOI: 10.1177/000313481608200731] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Neuroendocrine tumors (NETs) of the ampulla of Vater are rare neoplasms accounting for a small fraction of gastroenteropancreatic NETs. The optimal surgical approach remains controversial. This study aimed to define the optimal approach in patients with ampullary NETs. Patients who underwent resection of ampullary NETs from 2000 to 2014 were analyzed. Fourteen patients with well-differentiated, nonfunctional NETs were identified. The mean age was 60 ± 15 years, and nine (64%) were male. The mean tumor size was 1.6 ± 0.9 cm and the majority (61%) had an advanced tumor-node-metastasis stage. Eight (57%) patients underwent pancreaticoduodenectomy (PD) and six (43%) underwent transduodenal ampullectomy (TA). Although the mean tumor size was similar (1.7 vs 1.5 cm), the majority (75 vs 20%) of PD patients demonstrated a trend toward more aggressive tumors, characterized by advance T stage in 25 vs 0 per cent, lymph node positivity in 88 vs 17 per cent, and elevated proliferative index (Ki-67) in 25 vs 0 per cent. Complete resection (R0) was achieved in all PD patients versus 75 per cent in TA patients. There was no difference in major complication rate (50 vs 33%). In the TA group, one (17%) patient recurred and two (33%) patients died, whereas only one (13%) patient died in the PD group and no patients recurred. In conclusion, ampullary tumors can be aggressive tumors characterized by high regional lymph node involvement. A transduodenal approach may provide an inadequate oncological resection and thus has the potential to understage ampullary NETs. In the era of increasing therapeutic options for gastroenteropancreatic NETs, accurate staging is crucial and appropriate oncologic resection via PD for ampullary NETs should be considered.
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Affiliation(s)
- Gillian G. Baptiste
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Lauren M. Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Cecilia G. Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nina Le
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Maria C. Russell
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Charles A. Staley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Shishir K. Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
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A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis. J Gastrointest Surg 2016; 20:1098-105. [PMID: 27008594 DOI: 10.1007/s11605-016-3135-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/15/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs. METHODS Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified. Data on clinicopathologic characteristics and outcomes were collected and analyzed. RESULTS Local surgical resection (LR) was performed in 57 (39.0 %) patients, while 50 (34.3 %) patients underwent pancreaticoduodenectomy (PD) and 39 (26.7 %) patients an endoscopic resection (ER). Factors associated with worse RFS included advanced tumor grade and metastasis at diagnosis (both P < 0.05) but not procedure type (P > 0.05). Among patients who had at least one lymph node examined (n = 85), 50 (58.8 %) had a metastatic lymph node; lymph node metastasis (P = 0.04) and advanced tumor grade (P = 0.04) were more common among patients with tumors >1.5 cm. Median length-of-stay was longer for PD versus LR (P < 0.001). PD patients were at increased risk for severe postoperative complications (P = 0.01). CONCLUSION Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors ≤1.5 cm, LR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.
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29
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Tamburrino D, Spoletini G, Partelli S, Muffatti F, Adamenko O, Crippa S, Falconi M. Surgical management of neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 2016; 30:93-102. [PMID: 26971846 DOI: 10.1016/j.beem.2015.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
During the last decades an increase in the incidence of neuroendocrine tumors (NETs) was observed. Gastroenteropancreatic NETs represent the majority of NETs. Compared with their epithelial counterpart they usually have a more indolent behaviour and surgical resection improves survival. Tumor diameter is one of the main parameter in the decision making process for nonfunctioning forms. Generally, small lesions can be treated conservatively whereas larger tumors should be treated with standard surgical resection and lymphadenectomy. Functioning tumors should be resected regardless the dimension of the lesion. Locally advanced and metastatic disease should be also treated with extended resections, keeping in consideration the grading, size, Ki67, and presence of extra-abdominal disease. In the case of metastases the panel of operative treatment includes resection, ablation, up to liver transplantation.
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Affiliation(s)
- Domenico Tamburrino
- HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London Pond Street NW3 2QG, London, UK.
| | - Gabriele Spoletini
- HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London Pond Street NW3 2QG, London, UK.
| | - Stefano Partelli
- Pancreatic Surgery Unit, "Vita e Salute" University, San Raffaele Hospital, Olgettina n. 60 e n. 48, 20132 Milan, Italy.
| | - Francesca Muffatti
- Pancreatic Surgery Unit, "Vita e Salute" University, San Raffaele Hospital, Olgettina n. 60 e n. 48, 20132 Milan, Italy.
| | - Olga Adamenko
- Pancreatic Surgery Unit, "Vita e Salute" University, San Raffaele Hospital, Olgettina n. 60 e n. 48, 20132 Milan, Italy.
| | - Stefano Crippa
- Pancreatic Surgery Unit, "Vita e Salute" University, San Raffaele Hospital, Olgettina n. 60 e n. 48, 20132 Milan, Italy.
| | - Massimo Falconi
- Pancreatic Surgery Unit, "Vita e Salute" University, San Raffaele Hospital, Olgettina n. 60 e n. 48, 20132 Milan, Italy.
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30
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James AW, Chang L, Genshaft S, Dry SM. Coincident liposarcoma, carcinoid and gastrointestinal stromal tumor complicating type 1 neurofibromatosis: Case report and literature review. J Orthop 2015; 12:S111-6. [PMID: 26719605 PMCID: PMC4674501 DOI: 10.1016/j.jor.2014.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/24/2014] [Indexed: 02/02/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is associated with increased risk of multiple neoplasms. We present a case of a female patient with NF1 who presented with a rectal low-grade neuroendocrine (carcinoid) tumor. Computed tomography imaging found a well-differentiated liposarcoma and a well-circumscribed gastro-intestinal stromal tumor (GIST). Although GIST and carcinoid tumors are frequently found in NF1 patients, liposarcoma complicating NF1 is quite rare and this is the first reported case of well-differentiated liposarcoma in NF1. In summary, we report a case of coincident abdominal carcinoid tumor, GIST and well-differentiated liposarcoma, which illustrates the variability of neoplasms in NF1 patients.
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Affiliation(s)
- Aaron W. James
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Le Chang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Scott Genshaft
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sarah M. Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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31
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Untch BR, Bonner KP, Roggin KK, Reidy-Lagunes D, Klimstra DS, Schattner MA, Fong Y, Allen PJ, D'Angelica MI, DeMatteo RP, Jarnagin WR, Kingham TP, Tang LH. Pathologic grade and tumor size are associated with recurrence-free survival in patients with duodenal neuroendocrine tumors. J Gastrointest Surg 2014; 18:457-62; discussion 462-3. [PMID: 24448999 DOI: 10.1007/s11605-014-2456-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/06/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Duodenal neuroendocrine tumors are rare and few studies exist to guide surgical management. This study identifies factors associated with recurrence after resection. METHODS A retrospective, single institution review was performed between 1983 and 2011 on patients with a pathologic diagnosis of duodenal neuroendocrine tumor. Tumor grade was assigned based on WHO 2010 criteria (Ki-67 and mitotic rate). RESULTS Seventy-five patients were identified that underwent curative resection. This included 12 patients with endoscopic mucosal resection, 34 that had local resection, and 29 that underwent pancreaticoduodenectomy. Two-year and 5-year recurrence-free survival was 84 and 81%, respectively. There were 11 tumor recurrences (either local or distant), and four patients died of their disease (3/4 had high-grade lesions) with an overall median follow-up of 27 months. On univariate analysis, tumor size and tumor grade were identified as being associated with recurrence, but not intervention type, lymph node metastases, ampullary location, or margin status. CONCLUSIONS Tumor grade and size are associated with recurrence-free survival in duodenal neuroendocrine tumors. When feasible, a less aggressive surgical approach to treat low-grade and low-stage duodenal NETs should be considered.
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Affiliation(s)
- Brian R Untch
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA,
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Clinical outcomes for neuroendocrine tumors of the duodenum and ampulla of Vater: a population-based study. J Gastrointest Surg 2014; 18:354-62. [PMID: 24114680 DOI: 10.1007/s11605-013-2365-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 09/20/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous case series report that neuroendocrine tumors (NETs) of the ampulla of Vater have worse overall survival (OS) than NETs in the duodenum. We aimed to compare the OS of patients with ampullary NETs to patients with duodenal NETs. METHODS This retrospective comparative cohort study used the Surveillance, Epidemiology, and End Results (SEER) registry from 1988 to 2009. OS was evaluated using Kaplan-Meier estimates and Cox proportional hazard regression. RESULTS Ampullary NETs (n = 120) were larger (median size 18 vs. 10 mm, p < 0.001), higher grade (poorly and undifferentiated tumor 42 % vs. 12 %, p < 0.001), higher SEER historic stage (distant metastasis 16 % vs. 7 %, p < 0.001), and more often resected (78 % vs. 60 %, p < 0.001) than duodenal NETs (n = 1,360). Median OS was significantly worse for patients with ampullary NETs than with duodenal NETs (98 vs. 143 months, p = 0.037). Local resection was performed for 50.5 % of the resected ampullary NETs and resulted in similar OS compared to locally resected duodenal NETs (HR 1.37, 95 % CI 0.76-2.48, p = 0.291). CONCLUSIONS While ampullary NETs are more advanced at presentation and have worse OS than duodenal NETs, long-term survival is possible with proximal small bowel NETs. For locally resected NETs, OS is similar between ampullary and duodenal NETs.
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33
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Naalla R, Konchada K, Kannappan O, Lingadakai R. Duodenal carcinoid with carcinoid syndrome. BMJ Case Rep 2014; 2014:bcr-2013-202159. [PMID: 24414187 DOI: 10.1136/bcr-2013-202159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Carcinoid tumours are uncommon well-differentiated neuroendocrine tumours. Primary duodenal carcinoids account for less than 2% of all gastrointestinal carcinoids. Duodenal carcinoids are seldom associated with carcinoid syndrome. We report a rare case of duodenal carcinoid presenting as a carcinoid syndrome in a middle-aged man with upper abdominal pain, hot flushes, diarrhoea and dry cough. Endoscopy-guided biopsy and 24 h urine 5-hydroxyindoleacetic acid (5-HIAA) proved the diagnosis. He was further evaluated and managed with definitive surgical treatment.
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Affiliation(s)
- Ravikiran Naalla
- Department of General Surgery, Kasturba Hospital, Manipal University, Manipal, Karnataka, India
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34
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Waisberg J, Joppert-Netto G, Vasconcellos C, Sartini GH, Miranda LSVD, Franco MIF. Carcinoid tumor of the duodenum: a rare tumor at an unusual site. Case series from a single institution. ARQUIVOS DE GASTROENTEROLOGIA 2013; 50:3-9. [PMID: 23657299 DOI: 10.1590/s0004-28032013000100002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/16/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Duodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated. OBJECTIVE To analyze the clinicopathological characteristics of patients with resected duodenal carcinoids. METHODS Twenty patients (12 females and 8 males) were investigated. Their average age was 66.4 ± 5.8 years old (43 to 88 years old). The data corresponding to the clinical picture, diagnosis, treatment, and prognosis of patients with duodenal carcinoid tumors subjected to resection over a period of 18 years (1993-2011) were analyzed. RESULTS The most common symptoms were dyspepsia (50%) and epigastric pain (45%) followed by weight loss (10%) and vomiting (5%). Carcinoid syndrome was not observed in any patient. The lesion was located on the first part of the duodenum in 15 (75%) patients, the second part in 4 (20%) patients, and the third part in 1 (5%) patient. The diagnosis of a carcinoid tumor was established through an endoscopic excision biopsy in 19 (95%) patients and an histopathological examination of the surgical specimen in 1 (5%) patient. The average tumor size was 1.1 cm ± 0.4 cm (0.3 cm to 6.0 cm). Nineteen (95%) patients were initially treated by endoscopic resection of the duodenal lesion. One patient (5%), whose tumor was on the third part of the duodenum underwent a duodenectomy of the third and fourth duodenal parts and duodenojejunal anastomosis. The duodenal carcinoid resection margin was involved in four (20%) patients. Four (20%) patients were subjected to a partial gastrectomy to fully remove the lesion. The tumor was restricted to the submucosal layer in 16 (80%) cases, and it penetrated into the muscular layer in 4 (20%) cases. All patients exhibited positive chromogranin A, neuron-specific enolase, and/or synaptophysin immunostaining. The average duration of the follow-up period was 39.6 months (3 to 96 months). Twelve (60%) of the 20 cases in this series are alive without any evidence of active disease. Only one (5%) patient died due to liver metastases of the duodenal carcinoid. CONCLUSIONS Duodenal carcinoids are rare and indolent tumors usually associated with a benign progression. Duodenoscopy, computerized tomography, and endoscopic ultrasound should be performed to evaluate the tumor size, the level of wall invasion, and the presence of regional or distant lymphatic metastases. Endoscopic removal of tumors smaller than 1.0 cm without periampullary localization or evidence of muscular propria layer invasion assessed by histology and/or endoscopic ultrasound is recommended. The endoscopic resection with a carcinoid tumor size between 1.0 cm and 2.0 cm can be incomplete and require new endoscopic resection or even surgical removal. Duodenal carcinoid larger than 2.0 cm require full-thickness resection and concomitant lymphadenectomy.
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Affiliation(s)
- Jaques Waisberg
- Hospital do Servidor Público Estadual (IAMSPE), São Paulo, Brazil.
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O'Toole D, Delle Fave G, Jensen RT. Gastric and duodenal neuroendocrine tumours. Best Pract Res Clin Gastroenterol 2012; 26:719-35. [PMID: 23582915 DOI: 10.1016/j.bpg.2013.01.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 01/31/2023]
Abstract
Gastric neuroendocrine neoplasms (NENs) are increasing in frequency and have a varied spectrum with regard to histology, clinicopathologic background, stage, and prognosis. They are usually discovered incidentally, are for the most part benign and are associated with hypergastrinaemia (secondary either to chronic atrophic gastritis or rarely Zollinger-Ellison syndrome; types 1 and 2, respectively) or more rarely sporadic type 3. Applications of recent staging and grading systems - namely using Ki-67 proliferative indices - (from ENETS and WHO 2010) can be particularly helpful in further categorising these tumours. The natural history of Type 1 gastric carcinoids is generally (>95%) favourable and simple surveillance is usually recommended for small (<1 cm) T1 tumours, with local (endoscopic or surgical) resection for larger lesions. Other potential therapies such as somatostatin analogues and gastrin receptor antagonists may offer newer therapeutic possibilities. Rarely, gastric NENs have a malignant course and this is usually confined to Type 2 and especially Type 3 tumours; the latter mimic the biological course of gastric adenocarcinoma and require radical oncological therapies. Most duodenal NENs, apart from gastrinomas (that are not dealt with here) are sporadic and non functional. They are also increasing in frequency probably due to incidental discovery at endoscopy or imaging for other reasons and this may account for their overall good prognosis. Peri-ampullary and ampullary NENs may have a more aggressive outcome and should be carefully appraised and treated (often with surgical resection).
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Affiliation(s)
- Dermot O'Toole
- Department of Gastroenterology and Clinical Medicine, St James's Hospital and Trinity College, Dublin, Ireland.
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Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S, Ito A, Tomida A, Onishi S, Shirotsuki R, Okubo K, Narita M. A 12-mm carcinoid tumor of the minor duodenal papilla with lymph node metastases. Jpn J Clin Oncol 2012; 43:74-7. [PMID: 23136240 DOI: 10.1093/jjco/hys185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Carcinoid tumors located in the minor duodenal papilla are extremely rare, with only a few cases reported in the literature. Herein, we report the case of a 71-year-old man with a 12-mm carcinoid tumor at the minor duodenal papilla with lymph node metastases. Multidetector-row computed tomography with contrast enhancement revealed a 12-mm well-enhanced tumor in the duodenum. Upper gastrointestinal endoscopy showed a 12-mm submucosal tumor at the minor papilla of the duodenum. Biopsy specimens revealed a carcinoid tumor, and a subtotal stomach-preserving pancreatoduodenectomy was performed. Carcinoid tumors at the minor duodenal papilla have a high prevalence of nodal disease, even for tumors <2 cm in diameter. Therefore, we believe that radical resection with tumor-free margins (i.e. pancreatoduodenectomy) is the treatment of choice.
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Affiliation(s)
- Yasuyuki Fukami
- Department of Surgery, Toyota Kosei Hospital, 500-1 Josui-cho, Toyota, Aichi 470-0396, Japan.
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37
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Dumitrascu T, Dima S, Herlea V, Tomulescu V, Ionescu M, Popescu I. Neuroendocrine tumours of the ampulla of Vater: clinico-pathological features, surgical approach and assessment of prognosis. Langenbecks Arch Surg 2012; 397:933-43. [PMID: 22476195 PMCID: PMC3401309 DOI: 10.1007/s00423-012-0951-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/16/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS Neuroendocrine tumours occur very rarely in the ampulla of Vater and their clinical behaviour is unknown. The aim of this study is to assess the clinico-pathological features, surgical approach and prognosis of these patients. METHODS Six patients with neuroendocrine tumours of the ampulla of Vater treated with curative intent surgery at a single centre were retrospectively analysed. A univariate analysis of potential prognostic factors was also performed (data provided from the present study and literature review). RESULTS Pancreaticoduodenectomy was curative in all the patients. Overall and disease-free survival rates were significantly better for G1/G2 tumours (p = 0.006 and p = 0.004, respectively). Although frequent, lymph node metastases did not influenced both overall (p = 0.760) and disease-free survival rates (p = 0.745). No significant differences of survival were observed in patients with ENETS stage I/II disease, as compared to ENETS stage III disease (p = 0.169 and p = 0.137, respectively). No differences were observed according to UICC staging system (p = 0.073 and p = 0.177, respectively). Tumours that are less than 2 cm or limited to the ampulla appear to have a better prognosis. CONCLUSION The WHO 2010 classification appear to accurately predict patient prognosis, while the ENETS or UICC staging systems have a limited value (especially in regard to lymph node metastases). Radical surgery (i.e. pancreaticoduodenectomy with lymphadenectomy) should be the standard approach in most patients with NET of the ampulla of Vater because this procedure removes all the potential tumour-bearing tissue.
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Affiliation(s)
- Traian Dumitrascu
- Department of Surgery, Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Fundeni Street no 258, 022328 Bucharest, Romania
| | - Simona Dima
- Department of Surgery, Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Fundeni Street no 258, 022328 Bucharest, Romania
| | - Vlad Herlea
- Department of Pathology, Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Fundeni Street no 258, 022328 Bucharest, Romania
| | - Victor Tomulescu
- Department of Surgery, Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Fundeni Street no 258, 022328 Bucharest, Romania
| | - Mihnea Ionescu
- Department of Surgery, Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Fundeni Street no 258, 022328 Bucharest, Romania
| | - Irinel Popescu
- Department of Surgery, Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Fundeni Street no 258, 022328 Bucharest, Romania
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Abstract
INTRODUCTION Neurofibromatosis 1 is a tumor predisposition genetic syndrome with autosomal dominant inheritance and virtually 100% penetrance by the age of 5 years. NF1 results from a loss-of-function mutation in the NF1 gene, resulting in decreased levels of neurofibromin in the cell. Neurofibromin is a negative regulator of various intracellular signaling pathways involved in the cellular proliferation. Although the loss of heterozygosity in the NF1 gene may predispose NF1 patients to certain malignancies, additional genetic alterations are a prerequisite for their development. The precise nature of these additional genetic alterations is not well defined, and genetic testing of all malignancies in NF1 patients becomes an essential component of future research in this subset of patients. In addition to germline NF1 mutations, alteration of the somatic NF1 gene is associated with sporadic malignancies such as adenocarcinoma of the colon, myelodysplastic syndrome, and anaplastic astrocytoma. MATERIALS AND METHODS A comprehensive English and non-English language search for all articles pertinent to malignancies associated with NF1 was conducted using PubMed, a search engine provided by the U.S. National Library of Medicine and the National Institutes of Health. Key words searched included the following: "malignancies associated with NF1", "tumors associated with NF1", and "NF1 and malignancies". A comprehensive analysis in terms age and mode of presentation, investigation and therapeutic modalities, and outcome of the published data was performed and compared with similar information on the sporadic cases. RESULTS Malignancies in NF1 patients typically occur at an earlier age and, with an exception of optic pathway gliomas, certain types of malignancies carry a poor prognosis compared with their sporadic counterparts. Malignancies are the leading cause of death in NF1 patients, resulting in a 10- to 15-year decreased life expectancy compared with the general population. CONCLUSIONS The lack of well-defined screening tests for early detection and the nonspecific clinical presentation contributes to a poorer outcome in malignancies associated with NF1. Small study group size, mixed patient population, and a lack of uniformity in reporting research results make comparison of treatment outcome for this group difficult. An International Consensus Meeting to address and recommend best practices for screening, diagnosis, management, and follow-up of malignancies associated with NF1 is needed.
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Affiliation(s)
- Sachin Patil
- Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, New Jersey 07039, USA
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39
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Delle Fave G, Kwekkeboom DJ, Van Cutsem E, Rindi G, Kos-Kudla B, Knigge U, Sasano H, Tomassetti P, Salazar R, Ruszniewski P. ENETS Consensus Guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology 2012; 95:74-87. [PMID: 22262004 DOI: 10.1159/000335595] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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40
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Lee YH, Hsu MT, Tsai TJ. A botryoid lesion in the major duodenal papilla. Gastroenterology 2012; 142:e28-9. [PMID: 22107712 DOI: 10.1053/j.gastro.2011.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 01/25/2011] [Indexed: 12/02/2022]
Affiliation(s)
- Yi-Hsuan Lee
- Department of Pathology, Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
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41
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Valentino J, Evers BM. Recent advances in the diagnosis and treatment of gastrointestinal carcinoids. Adv Surg 2011; 45:285-300. [PMID: 21954695 DOI: 10.1016/j.yasu.2011.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Joseph Valentino
- Department of Surgery, Markey Cancer Center, The University of Kentucky, 800 Rose Street, CC140, Lexington, KY 40536-0093, USA
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42
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Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are composed of cells with a neuroendocrine phenotype. The old and the new WHO classifications distinguish between well-differentiated and poorly differentiated neoplasms. All well-differentiated neoplasms, regardless of whether they behave benignly or develop metastases, will be called neuroendocrine tumours (NETs), and graded G1 (Ki67 <2%) or G2 (Ki67 2-20%). All poorly differentiated neoplasms will be termed neuroendocrine carcinomas (NECs) and graded G3 (Ki67 >20%). To stratify the GEP-NETs and GEP-NECs regarding their prognosis, they are now further classified according to TNM-stage systems that were recently proposed by the European Neuroendocrine Tumour Society (ENETS) and the AJCC/UICC. In the light of these criteria the pathology and biology of the various NETs and NECs of the gastrointestinal tract (including the oesophagus) and the pancreas are reviewed.
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Affiliation(s)
- Günter Klöppel
- Department of Pathology, Technical University of München, Ismaninger Strasse 22, 81675 München, Germany.
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43
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The rare malignancy of the hepatobiliary system: ampullary carcinoid tumor. Case Rep Med 2011; 2011:173036. [PMID: 21687583 PMCID: PMC3114376 DOI: 10.1155/2011/173036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/09/2011] [Accepted: 04/12/2011] [Indexed: 12/03/2022] Open
Abstract
Introduction. Carcinoid tumors are low-grade tumors originating from endoderm and mostly involving the gastrointestinal system. However; they may be seen in any site within the gastrointestinal system. Case Presentation. A 69-year-old female patient. The results of blood tests were observed to be consistent with obstructive jaundice. A mass appearance was not encountered on tomographic examination. Papilla that was tumor-like macroscopically was seen in the second part of the duodenum in diagnostic endoscopy. Pylorus—preserving pancreaticoduodenectomy surgical procedure was applied. On pathological examination of the mass, a tumoral mass was detected in ampulla vateri localization, 1.5 × 1 × 0.8 cm in size, which, in immunohistochemical staining, was evaluated as a neuroendocrine tumor. Also, Metastasis was observed. Conclusion. The rarest type of carcinoid tumor is ampullary located carcinoid tumor, and tumor size is not a reliable indicator for tumor aggressivity in ampullary carcinoid tumors.
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44
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Lee JH, Lee KG, Oh YH, Paik SS, Park HK, Lee KS. Carcinoid tumors of the extrahepatic biliary tract: report of four cases. Surg Today 2011; 41:430-5. [PMID: 21365432 DOI: 10.1007/s00595-010-4256-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 01/17/2010] [Indexed: 12/19/2022]
Abstract
Carcinoid tumors located in the biliary tree are exceedingly rare, accounting for 0.2%-2% of all gastrointestinal carcinoids. This study describes four cases of carcinoid tumors of the extrahepatic biliary tract. Four carcinoid tumors arising in the common bile duct (Case 1, 59-year-old man), gallbladder (Case 2, 49-year-old man; Case 3, 65-year-old man), and ampulla of Vater (Case 4, 52-year-old woman) were studied. All of the cases were misdiagnosed before surgery as proximal bile duct cancer, stomach cancer with liver metastasis, gallbladder cancer, and adenocarcinoma of ampulla of Vater, respectively. The clinicopathological characteristics and clinical course were reviewed. Treatment depends on the location of the tumor and the extent of the disease. Aggressive surgical therapy with a curative intention therefore offers the only chance for cure and has to be considered whenever possible.
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Affiliation(s)
- Jae Hoon Lee
- Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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45
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Nikou GC, Toubanakis C, Moulakakis KG, Pavlatos S, Kosmidis C, Mallas E, Safioleas P, Sakorafas GH, Safioleas MC. Carcinoid tumors of the duodenum and the ampulla of Vater: current diagnostic and therapeutic approach in a series of 8 patients. Case series. Int J Surg 2011; 9:248-53. [PMID: 21215338 DOI: 10.1016/j.ijsu.2010.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 11/08/2010] [Accepted: 12/07/2010] [Indexed: 12/13/2022]
Abstract
AIM To describe the specific characteristics of duodenal/perivaterian carcinoids and to analyze the diagnostic/therapeutic approach. MATERIAL AND METHODS Eight patients were included in our study. Symptoms on admission included dyspepsia, upper gastrointestinal (GI) bleeding and anemia. All patients underwent upper GI endoscopy and gastrointestinal peptides (gastrin) and neuroendocrine markers (Chromogranin-A, CgA) measurement. Imaging studies were performed in all patients, including OCTREOSCAN, while in patients with ACs MRCP or ERCP was also performed, when necessary. Definite diagnosis was confirmed by histopathologic examination. RESULTS Polypoid masses (carcinoids) were revealed at duodenal bulb and ampulla of Vater, in 5 and 3 patients, respectively. Serum gastrin was moderately increased in 4 patients, while in one patient it was more than 1000 pg/ml. Serum CgA was moderately increased in one patient, in whom OCTREOSCAN detected a solitary hepatic metastasis. Two patients with DC, of less than 1 cm of diameter, were treated by endoscopic polypectomy, while all the other patients underwent surgery. The patient with hepatic metastasis and positive OCTREOSCAN received also Octreotide LAR, resulting in stabilization of disease. No recurrence or metastases were observed during follow-up (range : 1.5-9.6 years). CONCLUSIONS In DC tumors <1 cm endoscopic excision with close follow-up is an adequate treatment, while in tumors >1 cm and in AC, surgical resection is the treatment of choice. In metastatic tumors, resection of the primary lesion with administration of somatostatin analogues may stabilize the disease and improve patient's quality of life.
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Affiliation(s)
- George C Nikou
- Section of Gastrointestinal Neuroendocrinology, First Department of Propaedeutic Internal Medicine of Athens University Medical School, Laiko Hospital, Athens, Greece.
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46
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Ha DW, Kim GH, Kim DU, Bae MJ, Kim BW, Jeon HK, Park DY, Seo HI. A Case of a Neuroendocrine Carcinoma in the Minor Papilla. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 58:144-8. [DOI: 10.4166/kjg.2011.58.3.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Dong Woo Ha
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Jung Bae
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Bo Won Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hye Kyung Jeon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Do Yun Park
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Hyung Il Seo
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
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Scherübl H, Jensen RT, Cadiot G, Stölzel U, Klöppel G. Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management. World J Gastrointest Endosc 2010; 2:325-34. [PMID: 21160582 PMCID: PMC2998818 DOI: 10.4253/wjge.v2.i10.325] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/02/2010] [Accepted: 08/09/2010] [Indexed: 02/05/2023] Open
Abstract
Neuroendocrine tumors of the small bowel are on the rise. In the US they have increased by 300%-500% in the last 35 years. At the same time their prognosis is much improved. Today, most neuroendocrine tumors (NETs) of the duodenum are detected "incidentally" and therefore recognized at an early stage. Duodenal NETs which are well differentiated, not larger than 10 mm and limited to the mucosa/submucosa can be endoscopically resected. The management of duodenal NETs ranging between 10 and 20 mm needs an interdisciplinary discussion. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is recommended for well-differentiated duodenal NET tumors greater than 20 mm, for localized sporadic gastrinomas (of any size) and for localized poorly differentiated NE cancers. Surgery is recommended for any ileal NET. Advanced ileal NETs with a carcinoid syndrome are treated with long-acting somatostatin analogs. This treatment significantly improves (progression-free) survival in patients with metastatic NETs of the ileum. For optimal NET management, tumor biology, type, localization and stage of the neoplasm, as well as the patient's individual circumstances have to be taken into account.
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Affiliation(s)
- Hans Scherübl
- Hans Scherübl, Departments of Gastroenterology and Gastrointestinal Oncology, Vivantes Klinikum Am Urban, Berlin 10967, Germany
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48
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Kim YG, Kim TN, Kim KO. Carcinoid tumor of the minor papilla in complete pancreas divisum presenting as recurrent abdominal pain. BMC Gastroenterol 2010; 10:17. [PMID: 20149263 PMCID: PMC2828985 DOI: 10.1186/1471-230x-10-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 02/12/2010] [Indexed: 01/04/2023] Open
Abstract
Background Tumors of the minor papilla of the duodenum are extremely rare, and they are mostly neuroendocrine tumors, such as somatostatinomas and carcinoid tumors. However, true incidence of carcinoid tumors in minor papilla might be much higher, because patients with minor papillary tumors usually remain asymptomatic. We report a very unusual case of carcinoid tumor in a patient with complete pancreas divisum with a review of the literature. Case presentation A 56-year-old female patient was referred for evaluation of pancreatic duct dilatation noted on abdominal ultrasonography and computerized tomography. She complained of intermittent epigastric pain for 6 months. A MRCP and ERCP revealed complete pancreas divisum with dilatation of the main pancreatic duct. On duodenoscopy, a small, yellows, subepithelial nodule was visualized at the minor papilla; biopsy of this lesion revealed a carcinoid tumor. She underwent a pylorus-preserving pancreaticoduodenectomy. The histologic evaluation showed a single nodule, 1 cm in diameter, in the submucosa with duodenal and vascular invasion and metastasis to the regional lymph nodes. Conclusion Although the size of the carcinoid tumor was small and the tumor was hormonally inactive, the concomitant pancreas divisum led to an early diagnosis, the tumor had aggressive behavior. Carcinoid tumors of the minor papilla should be included in the differential diagnosis of recurrent abdominal pain or pancreatitis of unknown cause.
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Affiliation(s)
- Yong Gil Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
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49
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Pedicone R, Adham M, Hervieu V, Lombard-Bohas C, Guibal A, Scoazec JY, Chayvialle JA, Partensky C. Long-term survival after pancreaticoduodenectomy for endocrine tumors of the ampulla of Vater and minor papilla. Pancreas 2009; 38:638-43. [PMID: 19531971 DOI: 10.1097/mpa.0b013e3181a9d41f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Endocrine tumors of the ampullary region are rare, and accurate indications for their management are lacking. We aimed to evaluate the outcome of surgical treatment in this indication. METHOD We reviewed all patients who submitted to a pancreaticoduodenectomy for ampullary endocrine tumors between 1982 and 2003 in our center. RESULTS Eight patients, 3 men and 5 women, with a mean age of 47.8 years (range, 37-57 years) were included. Two patients presented with Zollinger-Ellison syndrome, and 1 had neurofibromatosis. Operative mortality was nil. The mean size of the tumors was 17.4 mm (range, 5-40 mm). There were 7 well-differentiated and 1 poorly differentiated endocrine carcinomas. Seven patients had satellite lymph node metastases, and 1 had diffuse liver metastases. Median follow-up was 131 months (range, 17-315 months). At the end of the follow-up period, 5 patients were alive and disease-free; 1 patient was alive with stable liver metastases. Two patients died 17 months and 13 years after surgery, respectively, from metastasis and an unrelated cause. CONCLUSION This study demonstrates the high frequency of lymph node invasion in these uncommon tumors, even at an early clinical stage. Pancreaticoduodenectomy may result in prolonged survival of patients with well-differentiated tumors.
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Affiliation(s)
- Roberto Pedicone
- Department of Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne, Lyon, France
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50
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Endocrine carcinoma of the major papilla: report of two cases and review of the literature. Surg Oncol 2009; 19:235-42. [PMID: 19586767 DOI: 10.1016/j.suronc.2009.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/09/2009] [Accepted: 06/01/2009] [Indexed: 02/07/2023]
Abstract
To date, about 100 cases of ampullary NET are reported in International literature. These tumors can cause symptoms mainly secondary to their periampullary location. Up to 25% of patients have von Recklinghausen's disease. Carcinoid syndrome is uncommon, unless hepatic metastasis is present. Determination of histopathology is of utmost importance and involves specific immunohistochemical staining. The published data indicate that these tumors, metastasize in approximately half of cases irrespective of primary tumor size. Therefore, radical excision in the form of pancreaticoduodenectomy is recommended regardless of tumor size. Local excision should be confined to patients unable to tolerate more extensive surgery. We here report two case of ampullary neuroendocrine tumors presenting as melena and painless jaundice respectively in a 51-year old man and in a 54-year old man and review the relevant literature, giving special attention to the morphologic features, clinical characteristics, and treatment modalities associated with this disease process.
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